Measuring Primary Process

They said it could not be done, but Bob Holt did it. When Holt began his empirical study of the psychoanalytic theories of thinking, he did so in the face of almost universal opinion in American psychology that (a) psychoanalytic ideas in general were insufficiently important to warrant experimental investigations and (b) psychoanalytic concepts of thinking in particular were so elusive and ephemeral that they would resist attempts at operational definitions. Some 50 years and hundreds of studies later, Holt and his research group have demonstrated that once again, received opinion about psychoanalysis has gotten it seriously wrong.

In Primary Process Thinking: Theory, Measurement,and Research, Holt (2009) recounts his and his team’s efforts to understand, assess, and explore this vague concept. As one of a group of bright students working with David Rapaport, Holt was exposed to attitudes and philosophy about psychoanalysis and the Rorschach that would serve him well throughout his career. Holt credits Rapaport for heading him in the right direction, but even his mentor would have been surprised by the discipline, energy, and creativity Holt gave to the process of unraveling and studying the many aspects of thinking, particularly primary process.

Early on Holt delineates six different Freudian views of thinking: dynamic, economic, topographic, structural, adaptive, and genetic (2009, p. 5). Each of these systems deals with primary process in a distinctive way. For example, in the economic model, “the cathecting (drive)-energy is free and easily capable of discharge by condensation and displacement” (Holt, 2009, p. 5); and in the adaptive model, primary process “cannot cathect anything unpleasant; it is ruled by the pleasure principle… [and] seeks gratification by the shortest path” (Holt, 2009, p. 5). Secondary process is also defined differently in each of the six systems. To this complex, confusing situation Holt brings a superordinate conviction: theories are most useful when they can be confirmed using directly observable data. Thus, the more remote a concept is from direct observation, the less useful it is (2009, p. 9). Using this criterion, he decided that “the economic point of view and related concepts had to be abandoned…the rest of metapsychology…was equally futile, being rife with logical or semantic flaws and referring to a hypothetical system and processes in it that were safely isolated from any contact with reality…hence empirically useless” (2009, p. 9). Primary process survived this Freudian housecleaning because Holt correctly inferred that examples of this kind of thinking might be found in responses to Rorschach blots. Many years of arduous labor by Holt and his colleagues provided ample evidence of this assumption.

Holt’s obvious, sensible conclusion that at some point psychodynamic concepts must be put to experimental test has even today eluded a great many psychoanalytic gatekeepers and members of the psychoanalytic establishment—important theoreticians, faculty members, directors of analytic institutes, journal editors. Psychoanalysis has paid a heavy price in the public press and in academic psychology for insisting that experimentally unsupported clinical evidence is sufficient to establish the usefulness and validity of psychoanalytic concepts and therapies. The material covered in the first three chapters of the book is a very strong, carefully considered, highly sophisticated analysis of the strengths and limitations of traditional Freudian positions. This critique alone should be required reading in all psychoanalytic institutes—but probably won’t be.

Chapter 2 briefly describes the development of a system for scoring Rorschach responses designed to assess primary process thinking. No specifics are provided here, but they are available in Volume II of the book and on a CD. It is evident that applying the system to a protocol requires considerable time and effort; it is also evident that if a response, however subtle, bears any relationship to primary process it will be detected and scored reliably. Primary process can appear in many forms, from frequent to seldom, from subtle to obvious, and from benign to overtly pathological, and Holt’s system catches these and assesses them appropriately. Despite the lengthy time required to score a protocol this way, Holt’s Primary Process method is widely applied. A recent examination of research using Rorschach blots (Masling, 2006) reported that 130 studies published in the United States and 7 foreign countries used the method; indeed, it was second in popularity only to the 176 studies published in the United States and 14 foreign countries that used Fisher and Cleveland’s (Fisher, l986) Barrier/ Penetration scores.

Chapter 3 presents Holt’s suggestions for “a new psychoanalytic theory of thinking” (2009, p. 51). It is a gem. Here we have an example of what psychoanalysis might look like if clinical insights were combined with solid, experimentally testable and empirically supported hypotheses. The data Holt relies on in his constructions are not limited to what is known from experiments in academic psychology, and also include recent scientific advances in neuroscience. Holt’s explicit intent in this section is to create a different way of considering psychoanalytic ideas in the hope “of saving the discipline from its own excesses and from Freud’s weaknesses as a scientist” (2009, p. 86). Holt’s version of a new psychoanalysis would not ignore the biological basis of ulcers or autism, for example, and would not treat new findings of brain functions as irrelevant.

Despite its many virtues, the book has several (minor) flaws. The literature Holt reviewed was essentially limited to that written by the group of scholars tutored by Rapaport. A somewhat different literature on primary process was reviewed in 1980 by Suler, and a more complete history of primary process would have cited Suler (1980) and includedthis other material. Although Holt mentions Schafer’s work (1954) on the interpersonal nature of the testing situation, the scoring system implicitly assumes that all Rorschach responses come exclusively from the test taker’s psyche with no influence of the situation or the examiner. There is abundant evidence that this is not so (Masling, 1966).

One further, personal note: glancing through the 19-page bibliography of experimental studies using Holt’s scoring system instantly arouses two feelings—optimism for the future of psychoanalysis, with large numbers of scholars willing to study and employ such an arduous, time-consuming research tool; and dismay that so many of these experiments, perhaps 40 percent, are unpublished dissertations. Why so many graduate students failed to publish their research is unknown. No doubt some tried but were put off by the lengthy, sometimes arbitrary, process of trying to please several anonymous reviewers and an editor. Some projects probably yielded negative results, leading the student or journal editors, or both, to lose interest, although this is a mistake because failure to confirm can be highly informative. Many students complete their dissertations only because they are required to do so; it will be the only research they conduct in their entire careers, and may be the only research they will read. In declining to publish their dissertations they fail to acknowledge the very social nature of the research endeavor—they received countless hours of faculty supervision and guidance and relied on the scholarship of all those whose work made their own research project possible. That they have an obligation to teach others as they have been taught and to repay this debt evidently is insufficient motivation to publish. Thus all the faculty time and help and the enormous time students give to their dissertation research are thrown away, with the research benefiting no one. Late in my academic career, after being disappointed by my students’ disinclination to give something back to the scholarly community, I employed a new tactic—raw coercion. When my student and I would negotiate an informal agreement about my accepting the role of dissertation sponsor, I would announce my intention of refusing to attend the final oral examination until the student showed me a letter from a journal editor acknowledging receipt of a manuscript based on the dissertation research. That tactic works 100 percent of the time. I heartily recommend it.